Objectives. Frontal plane QRS-T angle is a novel marker of myocardial repolarization, and an increased frontal plane QRS-T angle is associated with adverse cardiac outcomes. Slow coronary flow may cause fatal cardiac arrhythmias by causing electrical abnormalities and altering ventricular repolarization. We aimed to evaluate the frontal plane QRS-T angle in patients with slow coronary flow. Design. A total of 60 consecutive patients with slow coronary flow and 60 consecutive patients with normal coronary flow were enrolled into the study. Laboratory and some electrocardiography parameters including frontal plane QRS-T angle were compared between the two groups. Results. We have found that the angle of frontal QRS-T was higher in the group with slow coronary flow (p < .001). In addition, there was a negative correlation between thrombolysis in myocardial infarction frame count and frontal QRS-T angle (r = −0.496, p < .001). Conclusions. In conclusion, increased frontal plane QRS-T angle might be an important indicator of slow coronary flow.

Many hypotheses have been proposed to explain no-reflow (NR). Some of these hypotheses, state that NR may be caused by damage to the vascular endothelium and an inflammatory process. In a recent study that did not include patients with coronary artery bypass graft (CABG), the ratio of C-reactive protein (CRP) to albumin (CAR) was found to be associated with NR. Our study aims to evaluate the relationship between CAR and NR in patients who underwent percutaneous coronary intervention (PCI) for saphenous vein graft (SVG). In this retrospective study, among the patients with CABG who underwent primary or elective coronary angiography, 242 patients who underwent PCI to the SVG were selected. The incidence of NR was 19.8% (n = 48). Diabetes mellitus, left ventricular ejection fraction (LVEF), stent length, and CAR were found as independent predictors of NR in multivariate logistic regression analysis (P < .05). Using a cut-off level of .930, the CAR predicted NR with a sensitivity of 75% and a specificity of 73% (AUC: .814, 95% CI: .749–.879, P < .001). The CAR was a better predictor than both stent length and LVEF. CAR was found to be the strongest predictor of NR in our study.

Background: Bifurcation lesions pose unique challenges during percutaneous coronary intervention (PCI) and are associated with suboptimal outcomes. The standard approach involves provisional stenting of the main branch (MB) with plain balloon angioplasty (BA) for compromised side branches (SBs). It remains unclear whether drug-coated balloon (DCB) or plain balloon angioplasty pose a better strategy to treat SB in bifurcation lesions. This systematic review and meta-analysis compared the efficacy of DCB versus BA in managing SBs of bifurcation lesions. Methods: MEDLINE, Cochrane, and EMBASE databases were searched for randomized controlled trials (RCTs) comparing DCB and BA for treating bifurcation lesions. Outcomes included SB late lumen loss (LLL), major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), and target lesion revascularization (TLR). Results: Five RCTs were included, encompassing 1,255 patients, of whom 628 (50.4%) underwent DCB angioplasty; 946 (75.4%) were male, and the mean age was 63.5 years. Drug-coated balloons significantly reduced MI risk (risk ratio [RR] = 0.56, 95% CI: 0.35-0.88, P = .010). DCB use resulted in similar LLL in the SB compared with BA (mean difference (MD) = −0.12 mm, 95% CI: −0.24-0.01, P = .070). No significant differences were observed in TLR (RR = 1.19, 95% CI: 0.45-3.14, P = .720), MACE (RR = 0.70, 95% CI: 0.48-1.02, P = .070), and all-cause mortality (RR = 2.35, 95% CI: 0.61-9.00, P = .210). Conclusion: In this meta-analysis of RCTs, DCB significantly reduced MI without affecting LLL, TLR, MACE, and all-cause mortality compared with BA in the SB of bifurcation lesions.

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

Unusual clinical course Myocarditis is cardiac muscle inflammation caused by infectious or noninfectious agents. Rarely, clozapine, an atypical antipsychotic drug used to treat resistant schizophrenia, has been reported to cause myocarditis, as we report in this case. A 29-year-old man, who was known to have schizophrenia and was on olanzapine therapy, presented in our Emergency Department with active psychosis, and was subsequently admitted to the psychiatric ward for refractory schizophrenia. He was started on clozapine, which was cross-titrated with olanzapine. On day 20 of being treated with clozapine, he developed a high-grade fever and chest pain. EKG demonstrated new-onset prolonged QT corrected for heart rate (QTc), premature ventricular contractions, ST-T wave changes with an increased ventricular rate, and ventricular bigeminy with elevated troponin and inflammatory markers. Echocardiography showed a reduced left ventricular ejection fraction. Coronary angiography showed normal coronary arteries, low cardiac output, and cardiac index consistent with cardiogenic shock was also observed. Other pertinent laboratory results included negative respiratory viral panel, including COVID-19 PCR, negative blood cultures, and negative stool screen for ova and parasite. Clozapine was discontinued and the patient received management for heart failure with reduced ejection fraction. He improved clinically with return of EKG to normal sinus rhythm and improved left ventricular ejection fraction on repeat echocardiogram. Acute myocarditis can occur due to a myriad of causes, both infectious and noninfectious; thus, determining the lesser-known causes, such as drug-related etiology, is essential to provide appropriate treatment for patients.